Sex and age differences in patients treated surgically for acute subdural hematoma

Acute subdural hematoma (aSDH) is a severe condition with high mortality despite advances in neurosurgical care. Predicting outcomes remains challenging due to individual variability. This study explores sex- and age-related differences in surgical treatment and outcomes of aSDH.

How does sex and age influence surgical decision-making and outcomes in patients undergoing surgery for acute subdural hematoma?

We retrospectively analyzed 328 patients treated surgically for aSDH between 2005 and 2015. Demographic data, clinical characteristics (GCS), radiological parameters, surgical approach (osteoplastic craniotomy [OC] vs. decompressive craniectomy [DC]), and outcomes (Glasgow Outcome Scale [GOS]) at discharge were collected.

The cohort included 211 men (mean age: 56) and 117 women (mean age: 68). Hematoma volumes were similar between sexes (p = 0.9), yet surgical choices differed significantly (OC in 58 % of women vs. 43 % of men; p = 0.008). Elderly patients (>70 years; n = 133) had larger hematoma volumes than younger patients (64.6 vs. 44.8 cm³; p < 0.0001) and were more frequently treated with OC (68 % vs. 35 %; p < 0.0001). Age and hematoma volume-but not sex-were independent predictors of surgical approach. Outcome (GOS) was worse in elderly patients (p < 0.001) and those undergoing DC (p = 0.001). Time to CT correlated with outcome (p = 0.001), while time to surgery did not.

Despite comparable hematoma volumes, surgical strategies varied by sex and age. Elderly patients with larger hematomas were less likely to receive DC. These findings highlight demographic influences on surgical decision-making and support a more individualized approach in managing aSDH.